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US Laws | Affordable Health Care Act (HR3950F)
TITLE IV--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
Subtitle B--Increasing Access to Clinical Preventive Services

(B) by striking "and" before "(W)"; and (6755)

(C) by inserting before the semicolon at the end the following: ", and (X) with respect to personalized prevention plan services (as defined in section 1861(hhh)(1)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848". (6756)

(2) PAYMENT UNDER PHYSICIAN FEE SCHEDULE- Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting "(2)(FF) (including administration of the health risk assessment) ," after "(2)(EE),". (6757)

(3) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS- (6758)

(A) EXCLUSION FROM OPD FEE SCHEDULE- Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by striking "and diagnostic mammography" and inserting ", diagnostic mammography, or personalized prevention plan services (as defined in section 1861(hhh)(1))". (6759)

(B) CONFORMING AMENDMENTS- Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended-- (6760)

(i) in subparagraph (F), by striking "and" at the end; (6761)

(ii) in subparagraph (G)(ii), by striking the comma at the end and inserting "; and"; and (6762)

(iii) by inserting after subparagraph (G)(ii) the following new subparagraph: (6763)

"(H) with respect to personalized prevention plan services (as defined in section 1861(hhh)(1)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(X),". (6764)

(4) WAIVER OF APPLICATION OF DEDUCTIBLE- The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended-- (6765)

(A) by striking "and" before "(9)"; and (6766)

(B) by inserting before the period the following: ", and (10) such deductible shall not apply with respect to personalized prevention plan services (as defined in section 1861(hhh)(1))". (6767)

(d) Frequency Limitation- Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended-- (6768)

(1) in paragraph (1)-- (6769)

(A) in subparagraph (N), by striking "and" at the end; (6770)

(B) in subparagraph (O), by striking the semicolon at the end and inserting ", and"; and (6771)

(C) by adding at the end the following new subparagraph: (6772)

"(P) in the case of personalized prevention plan services (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;"; and (6773)

(2) in paragraph (7), by striking "or (K)" and inserting "(K), or (P)". (6774)

(e) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1, 2011. (6775)

SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN MEDICARE. (6776)(Text)

(a) Definition of Preventive Services- Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd)) is amended-- (6777)

(1) in the heading, by inserting "; Preventive Services" after "Services"; (6778)

(2) in paragraph (1), by striking "not otherwise described in this title" and inserting "not described in subparagraph (A) or (C) of paragraph (3)"; and (6779)

(3) by adding at the end the following new paragraph: (6780)

"(3) The term "preventive services" means the following: (6781)

"(A) The screening and preventive services described in subsection (ww)(2) (other than the service described in subparagraph (M) of such subsection). (6782)

"(B) An initial preventive physical examination (as defined in subsection (ww)). (6783)

"(C) Personalized prevention plan services (as defined in subsection (hhh)(1)).". (6784)

(b) Coinsurance- (6785)

(1) GENERAL APPLICATION- (6786)

(A) IN GENERAL- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 4103(c)(1), is amended-- (6787)

(i) in subparagraph (T), by inserting "(or 100 percent if such services are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual)" after "80 percent"; (6788)

(ii) in subparagraph (W)-- (6789)

(I) in clause (i), by inserting "(if such subparagraph were applied, by substituting "100 percent" for "80 percent")" after "subparagraph (D)"; and (6790)

(II) in clause (ii), by striking "80 percent" and inserting "100 percent"; (6791)

(iii) by striking "and" before "(X)"; and (6792)

(iv) by inserting before the semicolon at the end the following: ", and (Y) with respect to preventive services described in subparagraphs (A) and (B) of section 1861(ddd)(3) that are appropriate for the individual and, in the case of such services described in subparagraph (A), are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population, the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part". (6793)

(2) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS- (6794)

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